002247 (SATT)P.O. BOX 1504
Building 78-105 CALLE ESTADO
Address 80-512 P*bblP— Beach LA QUINTA, CALIFORNIA 92253
Owner
Mailing
Address
7S -VIS w*-ry Mih Vwivm
CityZip w Tel.
F ra�O 922260.
Contractor
. EAU Me and land_
Address
City - . lZip - ` I Tel
State Lic. I City
& Classif. 298130 Lic: # 328
Arch., Engr., - —
Designer
Address Tel.
City( Zip I
State
Lic. #
LICENSED CONTRACTOR'S DECLARATION .
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000)of Division.3 of the Business -and Professions Code, and my license is in full force and
effect.
SIGNATUREe IL 1.- •i r!:a: / f .✓"Xf_ 1 DATE
/OWNER -BUILDER DECLARATION
I hereby. affirm that I"am exempt from the Contractor's. License Law for the following
reason! (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant. for such permit to We a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he .is exempt therefrom, and the' basis ..
for the alleged exemption. Any violation of Section 7031.5 by 'any .applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars ($500):
❑ I, as owner of the property, or my employees with wages as their sole compensation, will,
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and'
. Professions Code: The Contractor's License Law does .not apply' to- an. owner of property' who .
builds. or improves thereon and who does such work himself or through his own employees, .
provided that such improvements, are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Dale Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of.
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
0 Copy is filed with the city. ❑ Certified copy is hereby furnished..
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg work for which this permit is issued, I shall not
employ any person in any manner so as* to become subject to the Workers' Compensation
Laws of California.
Date Owner -
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the' Workers' Compensation provisions of th'e Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked. -
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec: 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to '
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and slate that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above
mentioned property for inspection -,purposes.
Signature of applicant_ r. 1 i %:'f'"f �i��%e a' s' Date
Mailing Addressi.-
City, State, Zip
J j
t�
HARD COPY
` �
No. 002'9-17
7
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number
Legal Description
Project Description PM n6v ' Pim 10
Pham 8 B
Sq. Ft.GM 2272 5$22 No. No. Dw. 3
'Size Stories Units
New p Add ❑ Alter ❑,. Repair ❑ Demolition ❑
ZONE:
BY:
-timated Valuation
144t517.00 .
PERMIT,
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
462.89
Const.`
545.50
Mech. '
53.d1�
Electrical
102.17
Plumbing
128,50
S.M.I.
9*' 84
Grading
Driveway Eno.
4 8 331,390 CK
Infrastructure
2,000.00
TOTAL
3,303.90
REMARKS
ZONE:
BY:
Minimum Setback Distances:
Front Setback from Center. Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE
INSPECTOR
Issued by:
Date '^" Permit
Validated by:
Validation:
A5092
4 8 331,390 CK
CONSTRUCTION ESTIMATE
NO. ELECTRICAL EEUft
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SO. FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APP./EQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM. B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR ® 3/ac
HOUSE SEWER
REMARKS:
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
ROUND PLUM�JI�
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE 6 a go
OUGH PLUMB. O
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR SEPTI TA
(TROUGH WIRING
cJ O
DUCT WORK
ROCK STORAGE
QIQ FOUND. REINF. /Q
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP./EQUIP.
%(4REINF. STEELGAS
(FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INS P.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
_$
LUMBER GR.
INAL INSP./a �/
FRAMING
/ //
SINAL INSP.
o
ROOFING 7 F P /
VENTILATION
REMARKS:
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
��
RUL/1-ATHING V1, Cif
MESH
2L4(NSULATION/SOUND q
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
Of-'( w fAq- �, �l� ��o (Zcm—,